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Systems analysis of service coordination in domestic abuse, primary care and child mental health services

The impact of intimate partner violence (IPV) on parental and child mental health is well documented, as is the associated increased use of healthcare services by survivors of IPV. UK policy emphasises the importance of partnership working between health services and domestic abuse agencies, along with clear referral pathways for victims of violence and abuse and co-ordinated local responses. However, in general, current policy and guidance is focused on the response to adult victims with more limited advice as to how this should be operationalised for working with children.

With first author Dr Claire Powell (University College of London), VISION researchers Dr Olumide Adisa and Professor Gene Feder and others explored how services work together to support parents and children experiencing both parental IPV and parental or child mental health problems by drawing on the perspectives of professionals working in primary care, children and young people’s mental health services (CYPMHS), and domestic abuse services.

The team conducted a qualitative study, interviewing professionals in geographically contrasting local authority areas in England. They carried out framework analysis using a systems approach and mapping techniques to understand the service interrelationships and boundary judgements of professionals.

Results showed that

  • The relationships between domestic abuse services, CYPMHS, and primary care were complex, involving funders and commissioners, local authority strategic groups, and wider services such as schools and children’s centres.
  • Participants consistently identified a gap in the relationship between statutory CYPMHS and domestic abuse services.
  • There were mental health service gaps were for children living with ongoing or intermittent IPV and for children and parents with needs falling below or between service thresholds.
  • There was a gap in services for users of abusive behaviour to prevent future IPV.
  • Staff perspectives revealed differing views on treating the effects of trauma, and the co-ordination and sequencing of care.

Improving the response to children and adults experiencing mental health problems in the wake of IPV requires a systems perspective to understand the barriers to service co-ordination. The findings indicate a particular need to address the gap between CYPMHS and domestic abuse services.

To download the paper: Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives – ScienceDirect

To cite the paper:  Claire Powell, Olumide Adisa, Lauren Herlitz, Shivi Bains, Sigrún Eyrúnardóttir Clark, Jessica Deighton, Shabeer Syed, Ruth Gilbert, Gene Feder, Emma Howarth, Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives, Children and Youth Services Review, Volume 169, 2025, 108076, ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2024.108076

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The benefits system: source of support or hindrance to victims of violence?

Previous VISION research showed how 4% of domestic violence victims lose their job as a result of abuse and that half of unemployed women have experienced intimate partner violence in their lives.

A report just published by the Department for Work and Pensions (DWP) further confirms high levels of trauma and mental distress among people not in employment and approaching benefits services for support. The report focuses on those in receipt of Employment and Support Allowance (ESA) aimed at people with an impairment or health condition that affects how much work they do.

VISION researcher Sally McManus, with colleagues Claire Lapham and Ann Conolly from the National Centre for Social Research, analysed the government’s main mental health study. They found that nearly one in three (30%) ESA recipients screened positive for post-traumatic stress disorder. This was more than twice the rate for Jobseeker’s Allowance (JSA) claimants (12%), and ten times that of employed people (3%). The analyses show that the claimant population experienced high levels of stress, in which self-confidence was low and anxiety high. Compared to those in employment, few ESA claimants owned their home and many faced serious debt arrears.

Sally presented findings from this study as oral evidence to the Work and Pensions Committee’s Inquiry into Safeguarding Vulnerable Claimants, including domestic violence victims. She drew attention to calls from Women’s Aid for reform they highlight is needed to make the benefits system the lifeline survivors need, rather than a source of re-traumatisation and further harm.

Women’s Aid recommendations include implementing a named domestic abuse lead in every Jobcentre Plus and ensuring staff receive regular, specialist domestic abuse training, so that work coaches and other frontline staff are better able to recognise claimants experiencing domestic abuse. Specialist domestic abuse services need to be properly funded to support and advocate for survivors in making their claims to DWP. Extending the domestic violence easement to up to a year would also help, alongside exempting those who are moving to or from refuges from repayment of Jobcentre Plus advances.

The report can be downloaded from the DWP website: A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 – GOV.UK

To cite:

Claire Lapham, Anne Conolly, Sally McManus (2024): A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 DWP ad hoc research report no.79.

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Mental health outcomes of being a close relative of a serious assault victim

There is a now sizeable body of evidence that shows how violence can harm health, across different populations (e.g., violence experienced by older people or by people with insecure migration status) and contexts (e.g., violence within the workplace).

However, much less is known about the effects of violence on the close relatives of victims. This is particularly surprising considering the critical role that relatives play in providing support, care, and advocating for victims in the aftermath of violence.

VISION researchers, Dr Elizabeth Cook and Professor Sally McManus, address this gap in their recently published, Indirect victims of violence: mental health and the close relatives of serious assault victims in England, an open access article in Social Science & Medicine. They conducted a secondary analysis of the 2014 APMS (a cross-sectional, household mental health survey of 7,519 adults in England). Lizzie and Sally wanted to find out what proportion of the population was closely related to a victim of serious assault, and to assess whether being a relative was associated to poorer mental health outcomes.

They found that approximately 1 in 20 adults were closely related to a serious assault victim. The analyses showed that relatives were:

  • more likely to be anxious and twice as likely to be fearful in their neighbourhood
  • more likely to be dealing with multiple, other types of adversity such as their own experiences of serious assault and financial strains

Check out their piece, Families of victims of violent assault have double the risk of anxiety – new study, in The Conversation, where they discuss their findings further as well as the implications for government approaches to counting the costs of the effects of violence for society.

To read the article or download it free of charge:

https://www.sciencedirect.com/science/article/pii/S0277953624007329

To cite:

Cook, E. and McManus, S. (2024). Indirect victims of violence: mental health and the close relatives of serious assault victims in England. Social Science & Medicine.

To contact the authors:

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